Percutaneous full-endoscopic anterior transcorporeal cervical discectomy and channel repair: a technique note report

Abstract

Background Compared to anterior cervical discectomy and fusion (ACDF), cervical motion segment and disc was retained through anterior transcorporeal herniotomy (ATH). But surgical field and manipulation in traditional ATH was restricted by the narrow channel. Percutaneous full-endoscopic transdiscal cervical discectomy is a minimally invasive and functional spine surgery. However, significant loss of intervertebral disc height was inevitable. This study was done to illustrate the feasibility, safety, and efficacy and present our surgical experience of percutaneous full-endoscopic anterior transcorporeal cervical discectomy (PEATCD) and channel repair (CR) for the treatment of cervical disc herniation (CDH). Methods Four patients with CDH were chosen to undergo PEATCD and CR with a follow-up care for at least 22 months. The visual analogue score (VAS), Japanese Orthopedic Association (JOA), and modified Macnab criteria were recorded during the postoperative periods. CT images were obtained to observe the healing of the channel at 1 week and 3 months after the operation. Results The average operating time was 83.75 min. Drainage tubes were unnecessary. No procedure-related complications occurred. The postoperative VAS and JOA scores were improved compared to those of the preoperative assessment. The clinical efficacy was excellent in 3 patients and good in 1 patient at final follow up stage according to the modified Macnab criteria. The hernia was removed completely in all patients according to postoperative MRI. Migration of the repair implementation and collapse of the drilled vertebrae were not observed during the postoperative periods. The bony channel was nearly absent on CT images obtained at 3 months postoperative. Conclusion This is the first time that the anterior transcorporeal cervical discectomy and CR have been performed simultaneously under endoscopy. Less damage to disc and the retained cervical motion segment were achieved through this method. This is a feasible, safe, and minimally invasive procedure. Trial registration Numbers: ChiCTR1800016383 . Registered 29 may 2018. Retrospectively registered. Trial registry: Chinese Clinical Trial Registry. Electronic supplementary material The online version of this article (10.1186/s12891-019-2659-0) contains supplementary material, which is available to authorized users.

Percutaneous Full-Endoscopic Anterior Transcorporeal Cervical Discectomy for the Treatment of Cervical Disc Herniation: Surgical Design and Results

“…Combined with the advantages of full-endoscopic technique and anterior transcorporeal approach, PEATCD has acquired good therapeutic effects. However, how to design a bone channel with an appropriate size and proper direction for surgery has not been mentioned in these previous PEATCD reports (16)(17)(18)27,28).…”

Outcome of Anterior and Posterior Endoscopic Procedures for Cervical Radiculopathy Due to Degenerative Disk Disease: A Systematic Review and Meta-Analysis

“…One study included both anterior and posterior approaches (3.2%) 15 , 20 studies reported a posterior approach (64.5%), 6,7,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] and 10 studies reported an anterior approach (32.3%). 14,[34][35][36][37][38][39][40][41][42] All studies involved foraminotomy or discectomy by removing a disk fragment. Only one study reported fusion with an anterior approach using an intervertebral cage and iliac crest graft.…”

“…Two studies chose the trancorporeal approach. 39,41,43 The endoscopic variant is considered a motion-preserving approach for the cervical spine. It protects the disc from surgical damage.…”

“…39,41,43 Several surgical contraindications have been suggested, such as disc migration, disc herniation with foraminal stenosis, calcified herniated discs, obesity, previous surgery at the same level, and myelopathy. 39,41,43 A successful outcome was obtained in 89.6% (85.8-92.5%, P ¼ 0.000) of cases using the anterior approach, which is less than that seen with the posterior approach; additionally, anterior approach carried slightly higher complication rate compared to the posterior approach 7.9% (4.5-13.3%, P ¼ 0.000). A similar revision rate among the anterior vs. posterior approach was 4.2% (1.8-9.7%, P ¼ 0.000) vs. 4.00% (2.2-7.4%, P ¼ 0.000).…”

Clinical Application of Transforaminal Percutaneous Endoscopic Lumbar Discectomy Via Superior Notch of Inferior Vertebral Pedicle Approach for Very High-grade Inferiorly Migrated Disc Herniation

“…The nal follow-up modi ed MacNab criteria scores were recorded for evaluating the early clinical outcomes. The four grades of the modi ed MacNab criteria are as follows [11]: Excellent: Complete elimination of symptoms, work activities and quality of life returned to the original levels. Good: Mild symptoms, minor activity restrictions without affecting the routine work and quality of life.…”